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Predictors and prognosis for complex coronary lesions in patients with acute myocardial infarction: data from RICO
Gilles Rioufol1, Marianne Zeller, Gilles Dentan
1Service de Cardiologie, CHU Bocage, Bd Mal de Lattre de Tassigny, Dijon, France.
Insights
Multiple complex lesions (MCLs) in acute myocardial infarction patients indicate worse outcomes. C-reactive protein (CRP) levels and multivessel disease are key indicators for identifying patients at high risk for MCLs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Acute myocardial infarction (AMI) patients often present with complex coronary lesions.
- Understanding the determinants and outcomes of multiple complex lesions (MCLs) is crucial for risk stratification in AMI.
Purpose of the Study:
- To investigate the factors associated with multiple complex lesions (MCLs) in patients experiencing acute myocardial infarction.
- To determine the clinical outcomes and prognostic implications of MCLs in AMI patients.
Main Methods:
- Analysis of 1,152 consecutive AMI patients undergoing coronary angiography within 24 hours of admission.
- Complex lesions defined by thrombus, ulceration, irregular plaque, and flow impairment; MCLs defined as >1 complex lesion.
- Comparison of patient demographics, risk factors, and clinical outcomes between single complex lesion (SCL) and MCL groups.
Main Results:
- MCLs were identified in 31% of AMI patients.
- MCL patients were older, had more cardiovascular risk factors (excluding smoking), and higher C-reactive protein (CRP) levels.
- MCLs were independently associated with multivessel disease, altered left ventricular ejection fraction, increased risk of in-hospital cardiogenic shock, and higher 30-day and 1-year mortality.
Conclusions:
- The presence of MCLs in AMI patients signifies a poorer prognosis.
- Elevated CRP levels and multivessel disease are significant predictors for identifying patients with MCLs.
- Identifying MCLs aids in risk stratification and management of AMI patients.
Background:
We aimed to investigate the determinants and outcomes of multiple complex lesions (MCLs) on coronary angiography in patients with an acute myocardial infarction.
Methods:
One thousand one hundred fifty-two consecutive nonselected myocardial infarction patients who underwent coronary angiography within 24 hours after admission were analyzed. A complex lesion was defined by the presence of thrombus, ulceration, irregular plaque, and flow impairment. Patients with < or = 1 complex lesion were considered with single complex lesion (SCL), and patients with > 1 complex lesions with MCLs.
Results:
Multiple complex lesions were identified in 360 patients (31%). Patients from the MCL group were older and had a higher rate of cardiovascular risk factors but were less likely to be smokers when compared with the SCL group. Patients with MCLs were more likely to have altered left ventricular ejection fraction and multivessel disease and showed a trend toward an increased median time delay to revascularization (360 vs 285 minutes; P = .070). Moreover, the C-reactive protein (CRP) plasma levels increased with the number of CLs. By multivariate analysis, multivessel disease and CRP level were associated with the presence of MCLs. When compared with the SCL group, patients with MCLs had a higher risk of inhospital cardiogenic shock (18% vs 11%; P = .005) and 30-day mortality (11% vs 6%; P = .002). At 1-year follow-up, the presence of MCLs was an independent predictive factor of death.
Conclusions:
This study shows that the presence of MCLs is associated with worse outcomes and that risk factors such as CRP are able to identify patients at a high risk for MCLs.
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